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Wednesday, January 26, 2011

Perhaps the President has been stung by Republican accusations that he does not believe in American exceptionalism: the belief that America is unlike, and superior to, every other nation on earth. Perhaps he was simply using good communication skills to keep his audience cheering at the nation's annual pep rally. Whatever his motivation, American exceptionalism was a recurring theme in last night's State-of-the-Union speech.

What helps to set us apart as a nation, according to Mr. Obama? Well, there's our remarkable diversity, and our willingness to fight for our beliefs, and our successful businesses and world-renowned universities, and our creativeness and eagerness to do big things. We are inspired by the American Dream: our belief that each of us deserves the chance to shape our own destiny, that anything is possible no matter who we are or where we come from. And because we're so outstanding, we are a light to the world: we provide a moral example of freedom, justice, and dignity, and we influence other nations to move toward peace and prosperity. That's why, the President said, "there isn't a person here who would trade places with any other nation on Earth."

Not, of course, that we don't have problems. As Mr. Obama pointed out, our educational system continues to lag: many schools have low expectations and low performance, a quarter of our students drop out of high school; other nations surpass us in math and science and have a higher percentage of young people earning a college degree. Our infrastructure is crumbling: South Korea has better internet access than we do; Russia and many European countries invest more in roads and railways; China has faster trains and newer airports. Our finances are in trouble: we have a mountain of debt along with one of the highest corporate tax rates in the world.

But we can get past these problems and stay Number One! We can, in Mr. Obama's words, "out-innovate, out-educate, and out-build the rest of the world"! We did it 50 years ago when we thought the Russians might surpass us in space exploration. Let's do it again, this time by improving education, government, business, the infrastructure! (Oh, and by the way, sustaining the American Dream has always demanded sacrifice and struggle. We're going to have to take responsibility for the deficit. We'll need to make painful cuts to decrease debt. But enough with the gloom ... ) If we can dream it, we can do it!

I appreciate the President's faith in our country's traditional ideals. I am grateful that he appealed to Democrats and Republicans to work together to achieve them. I agree that the government needs to encourage innovation, reform education, and rebuild the infrastructure. I understand why he invoked American exceptionalism - national self-esteem - to motivate us.

But I am sorry he did not say more about the sacrifice and struggle we will all soon be facing.

By freezing spending, he told us, we can reduce the deficit by more than $400 billion over the next decade. Good start, Mr. President, but our national debt is over $14 trillion - that's nearly $130,000 per taxpayer - and growing larger every second. Our exceptional country has already mismanaged its finances so badly that, no matter what the government does now, most of us are going to have to seriously trim our lifestyles in the coming years. Some of us will face real poverty. At nearly 10 percent, our unemployment rate already surpasses that of most European Union countries. Housing prices appear to be falling yet again. State governments are deeply in debt. Our largest generation is starting to apply for Medicare. Yet Mr. Obama spoke only passingly of sacrifice, and his two Republican responders mentioned it not at all.

American exceptionalism is good when it increases our love for our country, when it reminds us of our founders' vision, when it drives us to increase opportunity and respect human dignity. It is dangerous when it allows us to ignore reality and hope for magical solutions where only sacrifice and hard work will do the job. Our world has seen many proud nations and empires; today most of them lie in ruins. In "Four Preludes on Playthings of the Wind," American poet Carl Sandburg paints a bleak picture of those forgotten places, now overrun by rats, lizards, and crows. Once, like us, they were powerful and rich. Once, like us, they sang:

Monday, January 24, 2011

When my father died in 1995, he immediately strode back into my imagination as the healthy, middle-aged man of my childhood, adolescence, and young-adult years. When my mother died four months later, my imaginary clock refused to turn back. For a long time I had a hard time seeing her any way except the way she was during her painful last years - unable to speak, unable to walk, profoundly depressed.

I've spent a lot of time going through old photos since then, and I can now - at least part of the time - see both my parents as the intelligent, attractive, well-respected people I knew throughout most of my life. I also enjoy imagining their life during their 17 years together before I was born (hint to mothers: if you have kept the shoebox full of letters you wrote your husband during your engagement, you might want to consider the merriment they will someday provide your children). I came to understand that my parents were not supporting actors in my personal drama, but leading actors in their own. I now realize that, though my mother and I were close in many ways, I never really knew her.

That realization was one reason I particularly enjoyed Ruth Reichl's Not Becoming My Mother, happily renamed in the paperback edition For You, Mom, Finally. And that was also why, when a friend recommended Circling My Mother by novelist Mary Gordon, I expected an equally satisfying read.I immediately identified with Gordon's story. Her mother was born in 1908, mine in 1910. I was born in 1948, she in 1949. Both mothers suffered from dementia; both spent their last years in nursing homes. My mother died at age 85; hers lived to be 94. Gordon, like me, was trying to get her mother back. Explaining the book's title, she writes:

I came to realize that I couldn't see my mother properly by standing in one place, by standing still. For the last eleven years of her life, the years marked by dementia, she was much more a problem to me than a joy. I wanted to move from the spot where I thought of my mother as a problem. To do this, I had to walk around her life, to view it from many points - only one of which was her career as my mother.

Gordon does this through ten essays, three of which were previously published. Many of the essays' titles begin "My Mother and ...", as in "My Mother and Her Bosses," "... Her Sisters," "... Her Friends," " ... My Father." In them, Gordon gives us a composite view of Anna Gagliano Gordon, daughter of a Sicilian immigrant father and an Irish immigrant mother, first of five daughters (there were also brothers), crippled by polio at age 3, a hard worker from age 17, married at 39, a mother at 41, widowed at 49, extremely devout Catholic, eventual alcoholic, and wearer of Arpège.

In the end, though, we learn a lot more about Mary than about Anna.

This is Mary's memoir, not Anna's. It is the story of a relationship as perceived by the daughter, not a portrait of the mother. It's the kind of book that all of us who have lost our mothers should write for our personal catharsis, but that few of us should publish.

Fortunately, Anna's daughter is a fine writer who entertains us with tales about mid-century Catholic immigrant life, moves us with stories of injustice and dysfunction and missed opportunities, and lets us share her pride as she pays tribute to a flawed but decent, imaginative, and self-giving woman.

Still, Mary Gordon knows she has not yet found her mother:

I will try to keep my mother from vanishing. I will try to understand distance, but to understand that I will also have to understand closeness. I must enter a world of undulations. A world where everything is moving, nothing is forever still....

I am trying to see my mother. I must begin now to learn how to look.

Memoir aficionadas will find Circling My Mother a treat. Women looking for ways to understand their own aging or dead mothers may also enjoy it, though it offers no advice beyond Gordon's own approach: To understand our mothers, we must circle them repeatedly. We must learn how to look.

Thursday, January 20, 2011

Republicans in the U.S. House of Representatives have voted to dismantle the health-care bill, whether by directly repealing it (which they can't do without the approval of the Democratically controlled Senate) or by chiseling away at its funding. They think they can improve on it. Fine. It's a flawed bill. Let the improvements begin.

If we're going to start from scratch, here are my 10 wishes for health-care policy. I want a system that

provides health care for every citizen and legal resident in the country

raises the number of physicians per capita

raises the number of hospital beds per capita

allows patients to choose their own doctors

lowers per capita spending on health care

lowers the health-care percentage of the GDP

raises life expectancy at birth

lowers adult mortality

lowers maternal mortality

lowers infant mortality

In other words, I want health care that is universal and widely available, allows free choice, saves money for the government as well as for individuals, and - of course - improves our health.

Are you waiting for pigs to fly? If so, check the skies above the following countries. Every country on this list has a health-care system that surpasses ours in all ten areas:

Austria

Belgium

Denmark

Finland

France

Germany

Ireland

Italy

The Netherlands

Norway

Spain

Sweden

Switzerland

Three other countries - Canada, the U.K., and Japan - surpass us in nine of the ten categories, even though they have fewer doctors per capita than we do.

What do they know that we don't know? Perhaps we should ask them. How about we send our members of Congress on an extended Western European fact-finding tour?

--------------------------If you enjoy looking up data on health-care systems, you can amuse yourself for hours at the World Health Organization's detailed database search.

Monday, January 17, 2011

If you like Anne Lamott's nonfiction, you'll love Lit. If you find Lamott's essays just a teensy bit irritating, try Lit anyway - you may like Mary Karr's approach better. If you've never heard of Lamott, this genre - kickass spiritual memoir - may not be high on your wish list. But there are other reasons to read Lit ...

When I first saw the title of the best-selling 2009 memoir, I figured it had something to do with literature, as in Mary Karr is an important poet in contemporary American lit.

I quickly realized that it also had a lot to do with alcohol, as in Karr couldn't function unless she was lit.

Toward the end of the book, I saw that it could also refer to light, as in Once Karr accepts the universe, and God, and love, she sometimes feels lit from within.

Two chapters into Lit, I already knew why it was named a best book of 2009 by the New York Times, "the New Yorker (Reviewer Favorite), Entertainment Weekly (Top 10), Time (Top 10), the Washington Post, the San Francisco Chronicle, the Chicago Tribune, the Christian Science Monitor, Slate, the St. Louis Post Dispatch, the Cleveland Plain Dealer, and the Seattle Times." Another chapter or two, and I couldn't put the book down.Admittedly, as memoir, Lit has two strikes against it. Only a tiny percentage of memoirs submitted to publishers ever become books (an editor once told me that when she sensed a memoir coming over the transom, she hid under her desk), and most published memoirs go out of print quickly. Memoir is an extremely difficult genre to get right. Our own stories, endlessly fascinating to us, rarely appeal to a broader audience. But Mary Karr's memoirs - this is her third - are lit.

Take, for example, her description of inner light, which I summarized so prosaically above. "Every now and then," Karr writes,

we enter the presence of the numinous and deduce for an instant how we're formed, in what detail the force that infuses every petal might specifically run through us, wishing only to lure us into our full potential. Usually, the closest we get is when we love, or when some beloved beams back.

Such lovely writing would have made this book a succès d'estime even if almost nobody ever bought it. But Karr is not just a poet, she's also a story teller and the creator of unforgettable characters. Her mother, for example:

Maybe any seventeen-year-old girl recoils a little at the sight of her mother, but mine held captive in her body so many ghost mothers to be blotted out. If my eyelids closed, I could see the drunk platinum-blond Mother in a mohair sweater who'd divorced Daddy for a few months and fled with us to Colorado to buy a bar. Or the more ancient Mother in pedal pushers might rise up to shake the last drops from the gasoline can over a pile of our toys before a thrown match made flames go whump, and as the dolls' faces imploded so the wires showed through, the very air molecules would shift with the smoke-blackened sky, so the world I occupied would never again be fully safe.

I could go on and on, pointing out Karr's Texas diction, wacky humor, eye for detail, and flashes of insight. You already know her story is about bad parenting, substance abuse, recovery, and conversion; I could add that it's also about depression and divorce and kind mentors and writing. But why describe dinner when food is already on the table? Put down the menu, pick up the fork, and dig in.

If you haven't yet met Chet and Bernie, allow me to introduce you. Bernie Little is founder and part-owner (with his ex-wife) of the Little Detective Agency, and Chet is his partner. This confuses some of his potential clients, since Chet is a very large dog of indeterminate breed. Bernie always assures the dubious that Chet was top of his class at the police dog training school, though this is not, strictly speaking, accurate. Chet explains:

I'd done pretty well in K-9 school, up until the very last day. The only thing left had been the leaping test. And leaping is just about my very best thing. Then came some confusion. Was a cat involved? And blood? I ended up flunking out, but that was how Bernie and I got together, so it worked out great.

Yes, gentle reader, Chet narrates the whole series. Don't think, though, that it in any way resembles Christmas letters you may have received from addled friends' family pets. As Stephen King blurbs on the back cover: "Spencer Quinn speaks two languages - suspense and dog - fluently."

Here are 10 reasons you might want to get acquainted with Chet and Bernie:

You've overdosed on bleak literary novels and want to read something funny for a change.

Thursday, January 13, 2011

Both books are about rich, feisty, brilliant, and often misunderstood and misrepresented British ladies who defied convention, traveled without male escorts in the Middle East, accomplished what male rivals only dreamed of, and made enormous contributions. The Smith sisters, twins born in 1843, were devout Scottish Presbyterians whose discoveries advanced the field of biblical studies; Miss Bell, born in 1868, was a North England atheist whose networking genius and intrepid desire for adventure helped to create the modern nation of Iraq. All three women were brilliant linguists. (My review of Sisters is here.)

Gertrude Bell, who has been called "the brains behind Lawrence of Arabia," made her first trip to Jerusalem in 1899 and died in Baghdad in 1926. During that tumultuous quarter-century, the political map of the Middle East was redrawn, and Bell was one of the principal mapmakers - literally, in that much of her work involved drawing maps to inform European diplomats, spies, and businessmen; and figuratively, in that she represented Mesopotamian interests at the 1919 Paris Peace Conference, participated in the 1921 Cairo Conference that created the British mandate over Mesopotamia, and was instrumental in making Faisal king of Iraq.That last sentence only hints at the genius that was Miss Bell. Of the 40 delegates to the Cairo Conference, she was the only female. Without her support, Faisal could never have navigated post-war political chaos and jockeying for power to become ruler of a nation that was not even his own. "I must tell you in confidence that he is my appointment," she wrote to her brother; "everyone is delighted, but they don't know it was I who did it."

And yet for years, Bell had had to endure "the disdain of her colleagues and the humiliation of working without an official position." She may have earned the respect of every sheikh in Araby, but to the British, she was merely a woman. When in 1916 her superior, Sir Percy Cox, finally gave her a salary and the official title of Liaison Officer, she became "the only female Political Officer in the British forces."

Just five years later, the New York Herald was calling her "Mesopotamia's Uncrowned Queen."

Though the book sometimes reads like a novel - and more than once made me wonder how author Janet Wallach could possibly have known that - Wallach says she based her account, right down to reported conversations, on Bell's voluminous letters and diary entries as well as on letters and memoirs written by her family and associates. In addition, Wallach visited many of the sites where Bell traveled and worked, and she has skillfully recreated a bygone era in both England and the Middle East.

Published in 1996, five years after the first Gulf War, the story of Iraq's formation is even more poignant now that fighting has destroyed so much of what Bell hoped - perhaps misguidedly - to create. Wallach's focus, though, is less on geopolitics than on the near mythical and eventually tragic character of Bell herself.

Bell was happy when she was hard at work, whether traveling by camel through uncharted desert, gathering data for British intelligence, schmoozing with world leaders at strategic conferences, or creating her beloved Baghdad Archaeological Museum (which was looted when U.S. forces invaded Iraq in 2003; click here for more information about the current state of the collection).

She was less happy back in England, where she felt out of place and was constantly reminded of several lost loves. Probably clinically depressed, she lost her appetite for life once her influence in Baghdad began to wane. Her closest friends had moved on to other assignments. Her typical work day dwindled from ten hours to three or four. Her father's fortunes had reversed, and she no longer had funds to finance further adventures. Her health was precarious. And one July night in 1926, just before her 58th birthday, she took an extra dose of sleeping pills.

Gertrude Bell, the extraordinary woman who became one of the most influential Europeans in the Middle East before she ever held an official position, was buried with full military honors.

"Newspapers throughout the world carried her obituary," Wallach writes:

- not just in notices but in long articles complete with her photograph - and in England, King George sent a message to the Bells:

'The Queen and I are grieved to hear of the death of your distinguished and gifted daughter whom we held in high regard.

'The nation will with us mourn the loss of one who by her intellectual powers, force of character and personal courage rendered important and what I trust will prove lasting benefit to the country and to those regions where she worked with such devotion and self-sacrifice. We truly sympathise with you in your sorrow.'

Monday, January 10, 2011

A public figure is shot. School children are shot. A building explodes. A package explodes. And immediately we look for someone or something to blame: Republicans? The Tea Party? Democrats? Muslims? The National Rifle Association? White Supremacists? The devil? Mental illness?

As Congresswoman Giffords fights for survival, perhaps we'll turn our soul-searching into a collective resolve to practice civility in both public and private discourse. But since we seem to be looking at others' souls rather than at our own, radical transformation seems unlikely.

The sad fact is that all of us are awash in violence.

I believe that political ads featuring targets and crosshairs - whether produced by Republicans, Democrats, or independents - are evil. I also believe, however, that they are metaphorical, not prescriptions for action. Alas, most of us voluntarily surround ourselves - and our children - with metaphors far more potent and pervasive than anything ever produced by a political committee.

The level of violence in even our PG-13 movies would have been unthinkable a generation or two ago (and back then, the special effects weren't nearly so gory, either). Movie previews - supposedly screened for general audiences - feature intrepid heroes and occasionally heroines gunning down the opposition (while driving like maniacs). Video games let adolescents go on imaginary killing rampages. Smaller kids buy action figures. Violent lyrics are common in popular music. TV violence outdoes TV sex. Popular books feature - and often describe in gruesome detail - murder, dismemberment, and rape - and all of these horrors are avenged by - you guessed it - violence.

It would be good if we could conduct debate without resorting to vitriolic ads and talk shows, of course. It would be good if automatic and semi-automatic weapons were available only to military and law enforcement personnel. It would be good if all mentally ill people had access to medical treatment (although, according to a report by the World Psychiatric Association, most acts of violence are committed by sane people, and most mentally ill people are non-violent).

But if we really want to stop the violence, we also need to pay close attention to our daily metaphors - the violent stories that change us for the worse while we think we are merely being entertained.

Wednesday, January 5, 2011

"The Obama administration, reversing course, will revise a Medicare regulation to delete references to end-of-life planning as part of the annual physical examinations covered under the new health care law, administration officials said Tuesday." Thus begins a New York Times article citing "procedural reasons" and "political concerns" as factors leading to the change. Clearly the administration does not want a resurrection of "death panels" hysteria. Alas, a widely misunderstood but sensible provision has bitten the dust.

Some people think the term end-of-life planning means "planning to end life." Not at all (though cleverer politicians might have come up with a less confusing term). End-of-life planning is not about euthanasia (illegal in all states) or physician-assisted dying (currently legal in Oregon, Washington, and Montana). Rather, it seeks to answer this question: When you come to the end of your life, what kind of medical treatment do you want?

Why should end-of-life planning be part of an annual physical?

1. All of us - even Boomers and politicians - are going to die.
If we are fortunate enough to have living parents, they are going to die too. Some of us will die too soon. We will have a fatal accident or contract a killer disease or succumb to the sudden failure of an essential body part. Some of us will die too late. We will continue to breathe long after our minds and bodies have shut down, or we will endure unspeakable pain for weeks, months, even years (and no, despite the advances in pain medication, not all pain can be removed). Unless we and our loved ones die suddenly, with no warning, all of us will eventually have serious decisions to make.

2. It is better to start thinking about end-of-life decisions before we have to face them.
If we are in pain, or terrified, or unconscious, or demented, or in a hospital bed, it is hard to research and consider our options. If we are willing to think about death before we're actually staring it in the face, however, we can consult not only with our physicians, but also with our clergy, our family members, and our friends.

3. If we don't write down our wishes in advance, someone else may make our decisions for us.
If we have a health-care power of attorney, that person will be a relative or friend we have chosen. If we do not, it may be a health-care worker that we don't even know or a relative that we wouldn't trust with our lives. If we have written down our wishes regarding end-of-life care, our agent is likely to follow them. If we have not, our care will depend on state law and our doctor's or agent's philosophy.

4. If we don't regularly review our advance directives, they may stop reflecting our wishes.
As people age, their attitude toward death may change. Twenty years ago, I was helping my parents fill out a form required by their nursing home. In case their hearts stopped beating and/or their breathing stopped, did they want (a) to spare no effort or expense in order to prolong life, (b) to be given life-sustaining treatment as long as they were not in an irreversible coma, or (c) no intervention if burdens would outweigh benefits? Without a second's hesitation, both of my parents said, "No intervention." Startled, I gently suggested that life-sustaining treatment might be the better option. "You are speaking as a person in her forties," said my father. "We are speaking as people in their eighties."

In addition, as medical science advances, new interventions may make our final days more comfortable - or less bearable. A yearly conversation with our doctor about end-of-life planning could help us make wiser decisions in light of continually evolving options.

5. End-of-life planning is about free choice, not rationing.
Advance directives are not about people who, with proper intervention, would return to health. They are about people who are going to die soon no matter what intervention is offered - people who are too ill, too injured, or too worn out to ever return to health. With intervention, they may prolong the dying process, adding a few days or weeks to their lives; but they may also add pain, the discomfort of being in hospital, and the possibility of being kept alive by machinery after their brains have ceased to function. Some people want all possible intervention; some prefer to let nature take its course. In the absence of an advance directive, health-care providers tend to opt for intervention. This can be very expensive - and why take money out of the Medicare pot to hospitalize those who would rather die naturally, perhaps at home or in a hospice, when that same money could be used to treat the dying who want those extra weeks?

* * * * *

Well, the health-care law was going to make it easier for Medicare recipients (and their children) by asking them to think about these things once a year. Now we're back on our own, and most of us will continue to pretend that we (and our parents) are immortal. While we nestle our heads in the comforting sand, some people will be getting state-of-the-art but ultimately futile treatments that they do not want, and other people won't be getting the heroic end-of-life measures that they urgently desire - and all so we can be free from the unbearable intrusion of having our personal physicians ask us if we'd like to talk about our wishes.

What you can do today

Fill out and sign a health-care power of attorney, listing the people you trust to make decisions for you if you are incapacitated; and an advance directive, specifying the degree of medical intervention you want if you are dying. In some states, the power of attorney includes a section on advance directives.

You can get these forms from doctors, hospitals, nursing homes, or attorneys. You can also download them right now, at no cost, from a variety of sites on the Internet. State laws differ, so be sure to get forms from your own state. For example, Illinois residents can get the combined health-care power of attorney and advance directives here and a living will (an advance directive for people who do not want intervention that prolongs dying) here.

Give copies of your signed forms to your doctor and to each person listed on your power of attorney.

Keep copies at home. Take copies to the hospital or emergency room when you or a loved one goes for treatment. Review your documents yearly, on your birthday or when you go for a physical exam.

Monday, January 3, 2011

Our house is anchored and insulated by books. We have floor-to-ceiling bookcases in the master bedroom, the guest bedroom, my study, David's study, a hallway in the basement, and the living room. We also have shorter bookcases in the front hallway, the guest room, the living room, and the basement.

Twenty-two years ago when we moved into our town house, we asked an interior designer to help us figure out furniture placement. The one requirement, we told her, was that three tall bookcases line the west wall of the living room. She looked at us, aghast. "Then it will look like a library!" she wailed. Yes, we said. Make it a very attractive library.

Hers

Some time later we moved the books from the west wall to the north wall. Immediately our home computer network stopped functioning as intended. The basement computer sometimes picked up the signal, often did not. Evidently the book wall was not letting the signal through. A signal booster on the main floor solved the problem, but I felt a bit sorry for the books. They knew what computers are doing to publishing, and they were only standing up for their rights.

David and I have reading chairs in the living room. Before company comes, we try to remember to reduce the height of our book stacks. But we thought you'd enjoy seeing them in their natural state.

And now I think I'll go get a cup of tea and sit in my reading chair for a while. Happy New Year, readers!